CANCER OF THE GULLET.—Extirpation of the growth is generally impracticable, and the use of dilating bougies is fraught with such danger of perforation and hemorrhage that they never should be employed. When the patient is still able to get his food through the narrowed tube he may be long kept in a tolerably comfortable state by judicious feeding; all nutriment must be liquid and administered at short intervals in small quantities and in concentrated form. Often the substitution of rectal feeding permits spasm, pain and irritation to subside after a few days' rest from swallowing, when liquid food by the mouth may be again resumed.
When the obstruction becomes so complete as to prevent the entrance of even liquid food to the stomach, a Symond's Tube should be gently introduced through the stricture upon the point of a flexible Bougie, and its funnel-shaped end made to rest upon the margins of the ring of diseased tissue above the obstruction; it is then left in situ, with its attached thread hanging out at the angle of the mouth, which should be fastened so as to avoid its being swallowed.
Upon failure to insert the tube there is usually no resource left but to perform gastrostomy and feed the patient through the opening made into the stomach, but this operation is often too long delayed; it should be performed before his strength has been undermined by starvation.
Kuester has reported favourably on the effect of Fibrolysin injections as a palliative administered with the view of inhibiting scar tissue growth in cancers of hard nature.
By the aid of the ccsophagoseopc it is now possible to remove small malignant growths by cesophagotomy when these are located in the cervical portion of the tube. The introduction of the principle of operating under differential pressure by the technique worked out by _Meyer raised the hope that malignant growths in the lower part of the gullet might be removed by the mediastinal route. The essential feature in his suggested scheme consisted in implanting the proximal stump of the oesophagus into the stomach after the latter had been pulled up into the thoracic cavity through a rent in the diaphragm.